Incidence and pathogenesis of late aneurysms after patch graft aortoplasty for coarctation

Fw, Hehrlein; Mulch, J; Hw, Rautenburg; Schlepper, M; Hh, Scheld

doi:10.1016/s0022-5223(19)35902-1

Cited by 97 publications

(13 citation statements)

References 12 publications

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“…The incidence of recoarctation reported after PATCH repair ranges from 2 to 21 %. [2][3][4][5][6][7][8][17][18][19][20][21] In the meta-analysis summary displayed in Table 1 (n = 7211, the overall mortality of PATCH was 5%, the recoarctation rate was 6%. There does appear to be a high incidence of ReCoA in neonates after PATCH, 21-50% in several series2r8-22 making this technique a poor choice for neonates.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Recoarctation and Results of Reoperation: A 40-Year Review

Dodge‐Khatami

Backer

Mavroudis

2010

Journal of Cardiac Surgery

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Background: We analyzed a single institution 40‐year experience with children that had coarctation repair to define risk factors for recoarctation and to evaluate the results of reoperation for recoarctation. Material and Methods: Between 1957 and 1998,271 patients had primary surgical repair of coarctation of the aorta. Techniques for primary repair included Gore‐tex patch aortoplasty (PATCH; n = 118), resection with extended end‐to‐end anastomosis (RXEEA; n = 69), subclavian flap aortoplasty (SFA; n = 61), resection with simple end‐to‐end anastomosis (ETE; n = 18), resection and interposition graft (n = 4), and extra‐anatomic graft (n = 1). Techniques for recoarctation repair included PATCH, interposition graft, and extra‐anatomic graft. Results: Median age at initial repair was 156 days. Major associated cardiac anomalies were present in 96 patients (35%). A hypoplastic aortic arch was present in 37 patients (14%). There were three early deaths (1%) and six late deaths (2%). One patient had paraplegia (0.4%). Recoarctation occurred in 29 patients (11%) and was most frequent with ETE and SFA repairs (33% and 20%, respectively). Multiple logistic regression analysis revealed ETE repair (p = 0.0002), SFA repair (p = 0.049), and aortic arch hypoplasia (p = 0.0001) to be risk factors for recoarctation. Using PATCH as the covariate, the odds ratio to develop recoarctation was 3.5 for SFA, 17.2 for ETE, and 15.2 for hypoplastic aortic arch. There was no mortality or paraplegia after recoarctation repair (n = 23). Six patients had seven balloon angioplasties; two of these patients later required reoperation. Three patients required a second reoperation for persistent coarctation. Conclusions: In our 40‐year review, simple end‐to‐end anastomosis and subclavian flap repair had the highest incidence of recoarctation, especially when associated with aortic arch hypoplasia. We recommend resection with extended end‐to‐end anastomosis for repair of neonates and infants and Gore‐tex patch aortoplasty for children over the age of 1 year. Surgical repair of recurrent coarctation is safe, effective, and has a low incidence of persistent coarctation.

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Section: Discussionmentioning

confidence: 99%

Risk Factors for Recoarctation and Results of Reoperation: A 40-Year Review

Dodge‐Khatami

Backer

Mavroudis

2010

Journal of Cardiac Surgery

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“…A coarctação da aorta é mais comumente tratada com correção anatômica, tais como ressecção do segmento estenótico e anastomose término-terminal ou aortoplastia com "flap" da artéria subclávia esquerda (crianças e adultos jovens) ou com ressecção do segmento estenótico e interposição de um tubo de Dacron entre a porção proximal e distal da aorta (segmentos longos e adultos). A aortoplastia, com colocação de "patch" e ampliação do segmento estenótico, também pode ser realizada, porém tem maior incidência de desenvolvimento tardio de pseudo-aneurisma (9,10) .…”

Section: Comentáriosunclassified

Tratamento cirúrgico da coarctação do arco aórtico em adulto: avaliação clínica e angiográfica tardia da técnica extra-anatômica

Lisboa

Filho

Dallan

et al. 2001

Rev Bras Cir Cardiovasc

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cirúrgico da coarctação do arco aórtico em adulto: avaliação clínica e angiográfica tardia da técnica extra-anatômica. Rev Bras Cir Cardiovasc 2001; 16(3): 187-94. RESUMO: Objetivo: Avaliar os resultados tardios da técnica extra-anatômica para correção da coarctação do arco aórtico em adultos. Casuística e Métodos: Entre 1979 e 2000, 15 pacientes foram submetidos à interposição de tubo de Dacron entre a aorta ascendente e descendente para correção da coarctação do arco aórtico. Onze (73,3%) pacientes eram do sexo masculino e a média de idade foi de 30,8 ± 12,1 anos (18 a 61 anos). A esternotomia mediana, com abordagem do pericárdio posterior, foi utilizada em 13 (86,7%) pacientes e a toracotomia lateral esquerda em 2 (13,3%). Em 3 (20,0%) pacientes foram realizados procedimentos associados e 4 (26,7%) eram reoperações. Os pacientes foram acompanhados por um período de 30 dias a 21 anos (média de 6,9 ± 6,7 anos) com avaliação clínica, ecocardiográfica e estudo angiográfico com ressonância magnética. Resultados: Não ocorreram complicações neurológicas e nem mortalidade imediata ou tardia. Não houve necessidade de reoperações e nem complicações tardias com o enxerto. Todos os pacientes encontram-se assintomáticos e com o enxerto pérvio confirmado pelo ecocardiograma. Cinco (33,3%) pacientes apresentam hipertensão arterial sistêmica de grau leve. Em 11 (73,3%) pacientes foi realizado o estudo angiográfico com ressonância magnética, mostrando enxerto com bom funcionamento a longo prazo. Conclusão: A técnica extra-anatômica, com interposição de tubo de Dacron entre a aorta ascendente e descendente, para correção da coarctação do arco aórtico é uma operação segura, com baixa morbidade e mortalidade. Os bons resultados a longo prazo mostram que esta técnica pode ser uma alternativa segura e menos invasiva, para a correção de coarctação do arco aórtico ou recoarctação em adultos. DESCRITORES: Coartação aórtica, cirurgia. Aorta torácica, anormalidades. Coartação aórtica, radiografia. Aorta torácica, cirurgia. Aorta torácica, radiografia. Angiografia coronária. Tratamento cirúrgico da coarctação do arco aórtico em adulto: avaliação clínica e angiográfica tardia da técnica extra-anatômica RBCCV 44205-546

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“…In a study including 317 patients with patch aortoplasty, Hehrlein et al [ 24 ] showed that 18 patients (5.7%) developed an aneurysm. Twelve patients (66.7%) underwent extensive resection of the intimal layer, the so-called fibrous coarctation membrane, which was the only factor predictive of developing an aneurysm.…”

Section: Discussionmentioning

confidence: 99%

Successful implantation of a decellularized equine pericardial patch into the systemic circulation

Dohmen

Costa

Lopes

et al. 2014

Med Sci Monit Basic Res

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BackgroundIn the past, successful use of decellularized xenogenic tissue was shown in the pulmonary circulation. This study, however, evaluates a newly developed decellularized equine pericardial patch under high pressure circumstances.Material/MethodsSeven decellularized equine pericardial scaffolds were implanted into the descending aorta of the juvenile sheep. The implanted patches were oversized to evaluate the durability of the decellularized tissue under high surface tension (Law of Laplace). After 4 months of implantation, all decellularized patches were inspected by gross examination, light microscopy (H&E, Serius red, Gomori, Weigert, and von Kossa straining), and immunohistochemical staining.ResultsThe juvenile sheep showed fast recovery after surgery. There was no mortality during follow-up. At explantation, only limited adhesion was seen at the surgical site. Gross examination showed a smooth and pliable surface without degeneration, as well as absence of aneurysmatic dilatation. Light microscopy showed a well preserved extracellular scaffold with a monolayer of endothelial cells covering the luminal side of the patch. On the outside part of the patch, a well developed neo-vascularization was seen. Host fibroblasts were seen in all layers of the scaffolds. There was no evidence for structural deterioration or calcification of the decellularized equine pericardial scaffolds.ConclusionsIn the juvenile sheep, decellularized equine tissue showed no structural deterioration, but regeneration and remodeling processes at systemic circulation.

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Incidence and pathogenesis of late aneurysms after patch graft aortoplasty for coarctation

Cited by 97 publications

References 12 publications

Risk Factors for Recoarctation and Results of Reoperation: A 40-Year Review

Risk Factors for Recoarctation and Results of Reoperation: A 40-Year Review

Tratamento cirúrgico da coarctação do arco aórtico em adulto: avaliação clínica e angiográfica tardia da técnica extra-anatômica

Successful implantation of a decellularized equine pericardial patch into the systemic circulation

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